Session Item

Saturday
August 28
08:00 - 08:40
N103
The role of RTT leadership in advancing multi-disciplinary research
Sophie Perryck, Switzerland
0070
Teaching lecture
RTT
08:53 - 09:01
Impact of sarcopenia on survival and recurrence after radiotherapy for head and neck cancer
PH-0039

Abstract

Impact of sarcopenia on survival and recurrence after radiotherapy for head and neck cancer
Authors: Thureau|, Sebastien(1)*[sebastien.thureau@gmail.com];Lebret|, lucie(1);Dandoy|, Simon(1);Ebran|, Mélanie(1);Gouley Toutain|, Céline(2);Guerault|, Fanny(1);Lefebvre|, Laureline(1);Mallet|, Romain(1);Moldovan|, Crisitian(3);Veresezan|, Ovidiu(1);Lequesne|, Justine(4);Modzelewski|, Romain(5);Clatot|, Florian(3);
(1)Center Henri Becquerel, Radiotherapy, Rouen, France;(2)Center Henri Becquerel, Supportive Care, Rouen, France;(3)Center Henri Becquerel, Medical Oncology, Rouen, France;(4)Center Henri Becquerel, Clinical Research Unit, Rouen, France;(5)Center Henri Becquerel, Medical Informatic, Rouen, France;
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Purpose or Objective

Sarcopenia is frequent at the diagnostic of head and neck squamous cell carcinoma (HNSCC). We aimed to assess the prognostic impact of sarcopenia on survival among patients treated by radiotherapy or radiochemotherapy for HNSCC.

Material and Methods

The monocentric NutriNeck study (NCT02900963) recruited all HNSCC patients between 2014 and 2018 treated by RT or RTCT in curative intent. Patients fed by enteral nutrition before RT initiation were excluded. Clinical and biological data, planned volumes and doses of treatment were collected at baseline. Daily evaluation of the weight and weekly clinical, biological and food intake evaluation were performed during RT/RTCT. In case of 2 kg weight loss under treatment, enteral feeding by tube was proposed. Complete treatment was defined as full planned RT doses without more than 3 days interruption, and full planned doses of cisplatin and cetuximab if indicated. Sarcopenia was determined by measure of skeletal muscles at the third lumbar vertebra on the planning CT-scan of radiotherapy. Sarcopenia was defined as SMI (Skeletal muscle index) less than 52.4cm²/m² for men and 38.5cm²/m² for women.

Results

 Among the 257 HNSCC patients included, 120 (47%) were treated by RT and 137 (53%) by RTCT. The mean age was 60.8 years with 196 men (76%) and 61 (24%) women. Before radiotherapy, 94 (37%) patients were sarcopenic. Sarcopenia was more frequent among men (40.7%) than women (25%) (p=0.04). 65 patients (25%) did not complete treatment, all but 3 in the RTCT group. Median weight lost was higher among patients who did not complete treatment (7 vs 4.3 kg, p<0.0001), as well as patients with grade 3 toxicities (53 vs 34%, p=0.012). At 18 months, overall survival (OS) was 75% in sarcopenic patients vs 86% in non-sarcopenic patients (p=0.0002). Progression free survival (PFS) was also decreased in case of sarcopenia (61 vs 80%, p<0.0001). The poor prognostic value of sarcopenia at 18 months OS was observed among patients treated by RTCT (79% vs 87%, p=0.01) or by RT (72% vs 84%, p=0.009). PFS was also decreased in case of sarcopenia for patients treated by RTCT (68% vs 79%, p=0.01) or by RT (54% vs 80%, p=0.0008).

Conclusion

This study confirms that pretherapeutic sarcopenia is very frequent and can predict OS and PFS in patients treated with RTCT or RT for HNSCC. Specific management of this at-risk population is therefore essential.